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The U.S. Food and Drug Administration said on Saturday it will detain shipments of pomegranate seeds from Turkey as health officials have narrowed the likely cause of a Hepatitis A outbreak that has sickened at least 127 people in 8 states. On Sunday, one of the frozen berry recalls associated with the outbreak expanded.

The agency has worked with the Centers for Disease Control and state and local health authorities for several weeks to try and track down the ingredient making people sick. Health officials have now determined that the “most likely vehicle” for the virus appears to be a common shipment of pomegranate seeds from Goknur Foodstuffs Import Export Trading of Turkey that were used by Townsend Farms to make Organic Antioxidant Blend, a mix of frozen berries, sold to Costco and Harris Teeter stores.

FDA is now barring Goknur from shipping pomegranate seeds into the United States. It is not clear how much product is impacted, but an FDA official noted that Turkey is a “minor player” compared to countries like India, Iran, China, and Thailand, when it comes to providing pomegranate to the U.S. market.

“This outbreak highlights the food safety challenge posed by today’s global food system,” said Michael Taylor, deputy commissioner for foods and veterinary medicine, in a press release over the weekend. “The presence in a single product of multiple ingredients from multiple countries compounds the difficulty of finding the cause of an illness outbreak. The Hepatitis A outbreak shows how we have improved our ability to investigate and respond to outbreaks, but also why we are working to build a food safety system that more effectively prevents them.”

The Townsend Farms blend has been linked to the multistate outbreak affecting mostly western states. According to CDC, about half of the reported Hepatitis A cases are in California.

Colorado has reported 25 and Arizona 17. Hawaii is reporting 7, New Mexico and Nevada have 5 cases and Utah and Wisconsin have 2 each. The cases reported in Wisconsin, however, resulted from exposure to the product in California, according to health officials.

Nearly 60 percent of those sickened are women. The ages in the outbreak range from 2 to 84 and include 6 children under the age of 18. CDC said none of the children had been vaccinated. More than half of those ill required hospitalization.

The outbreak strain of hepatitis A virus, belonging to genotype 1B, is rarely seen in the Americas but circulates in North Africa and the Middle East, according to CDC.

On Sunday, FDA announced the Townsend Farms frozen berry recall has been expanded again. The company is now recalling Townsend Farms Organic Antioxidant Blend, 3 lb. bag with UPC 0 78414 40444 8. The codes are located on the back of the package with the words “BEST BY” followed by the code T122114 sequentially through T053115, followed by a letter. All letter designations are included in the voluntary recall, according to the expanded recall announcement.

The announcement also said that the epidemiological evidence “does not support an association between the illness outbreak and the four other berry products (raspberry, blueberry, strawberry and dark cherry) in the Frozen Organic Antioxidant blend,” which were also used in other Townsend Farms products, so consumers do not have reason to be concerned about those berries.

Townsend Farms said an FDA inspection of the company’s frozen fruit repacking operations has been completed. “The FDA found no evidence linking either the Townsend Farms, Inc.’s repacking facility or any food handler who had possible contact with the product to the source of the illness outbreak,” according to the release.

Hepatitis A, a liver disease, can range from mild to severe and can last anywhere from a few weeks to several months. Symptoms usually occur within 15 to 50 days of exposure and include fatigue, abdominal pain, jaundice, abnormal liver tests, dark urine and pale stool.

If a person has been exposed to the Hepatitis A virus within two weeks or less, they may be able to prevent the disease by receiving a vaccine. Consumers who may have eaten recalled product or have Hepatitis A symptoms should consult with their healthcare provider or their local health department.

No illnesses have been connected to the Woodstock brand pomegranate kernels, but they were imported from Turkey and may be associated with the imported pomegranate kernels implicated in the ongoing Townsend Farms frozen berry hepatitis A outbreak that has sickened at least 122 people in eight states.

The products are sold in 8-oz. resealable plastic pouches with UPC Cod 0 42563 01628 9. Further coding information is on the back portion of the pouches below the zip-lock seal. The following lots are subject to recall:

C 0129 (A,B, or C) 035 with a best by date of 02/04/2015

C 0388 (A,B, or C) 087 with a best by date of 03/28/2015

C 0490 (A,B, or C) 109 with a best by date of 04/19/2015

The products were shipped between February 2013 through May 2013 to UNFI distribution centers in California, Colorado, Connecticut, Florida, Georgia, Indiana, Iowa, New Hampshire, Pennsylvania, Rhode Island, Texas, and Washington State. UNFI distribution centers may have further distributed products to retail stores in other states.

Symptoms of hepatitis A infection generally appear within 14 to 50 days of exposure and include fatigue, abdominal pain, jaundice and dark urine.

Those who receive a vaccination within two weeks of exposure may prevent illness, and anyone who has already received a hepatitis A vaccination in the past is not at risk of infection.

Thousands of people in the western United States have received hepatitis A vaccines since news broke on May 31 of an outbreak linked to Townsend Farms frozen berry mixes sold at Costco stores.

More than 10,000 people have received the vaccine from Costco pharmacies alone, according to Craig Wilson, Costco’s vice president of quality assurance and food safety.

That number does not include the customers who have been vaccinated elsewhere and then brought in receipts to receive reimbursement from Costco, Wilson said. He was not sure of the number of reimbursements Costco had issued.

Wilson credited local and county health departments in affected states with handling countless more vaccinations. The only state health department contacted by Food Safety News that could report a solid figure of vaccines delivered by government health departments was Colorado, which had given out 397 shots across the state as of June 13.

The county health departments of Los Angeles and San Diego in California and Maricopa in Arizona each administered a large number of vaccines, Wilson said. Those health departments were not able to report actual numbers to Food Safety News as of press time. The California Department of Public Health was also not sure of how many shots had been given statewide.

(Update, 6/24: The Los Angeles County Department of Public Health has told Food Safety News it has given out more than 900 vaccinations.)

Wilson also said it was worth noting that no microbial testing had actually found the outbreak strain of hepatitis A on any berries from Townsend Farms. The rare outbreak strain isolated from patients, genotype 1b, originates from North Africa and the Middle East, leading investigators to single out the berry mix’s pomegranate seeds imported from Turkey.

“There’s been no microbial connection to the food through today as far as I’m aware of,” Wilson said.

Costco plans to continue selling Townsend Farms products once the outbreak has resolved, Wilson said, “as long as they’re doing everything they’re supposed to from a quality and food safety and testing perspective.”

To date, the U.S. Centers for Disease Control and Prevention have linked 113 confirmed infections of hepatitis A to Townsend Farms’ Organic Antioxidant berry blend. Of those sick, 50 people have been hospitalized. Townsend Farms announced a recall of the product sold at Costco and Harris Teeter stores on June 4.

Costco estimates that it sold 330,000 bags of the recalled product since February 2013. The retailer said it has contacted approximately 240,000 customers via phone and letters to inform them of the recall.

The Food & Drug Administration has launched an investigation into Fairview, OR-based Townsend Farms after a rarely-seen strain of hepatitis A has caused 30 illnesses and preliminary epidemiological studies are pointing the finger at the Townsend Farms Organic Anti-oxidant Blend frozen berry mix.

As of May 31, 30 people in five western states have become ill with hepatitis A, and 11 of the 17 people interviewed by health officials reported eating the frozen berry and pomegranate seed mix purchased from Costco, according to the Centers for Disease Control & Prevention.

Preliminary tests show the outbreak strain is genotype 1B, which is rarely seen in the Americas and circulates mainly in North Africa and the Middle East, CDC said. In fact, the genotype was identified in an outbreak in Europe linked to frozen berries earlier this year, and another outbreak in Canada linked to a frozen berry blend with pomegranate seeds from Egypt in 2012.

The Townsend Farms Organic Anti-oxidant Blend frozen berry mix associated with illnesses contained pomegranate seeds and other produce from the United States, Argentina, Chile and Turkey, according to the product label.

Townsend Farms, a sixth-generation family farm that markets fresh and frozen berries, says on its website that it is an early adopter of the Produce Traceability Initiative, and follows Good Agricultural Practices and Good Manufacturing Practices.

Along with inspecting the Townsend Farms’ processing facilities, FDA said that it is developing a protocol to test berries for the hepatitis A virus and will be testing samples related to the outbreak.

In the meantime, Costco is notifying its members who purchased the product since February, and the retailer removed the product from its shelves, CDC stated. No official recall has been announced as of press time.

California officials are advising consumers to contact their doctors if they have consumed the product in the last two weeks. Three of the six confirmed illnesses in that state have been hospitalized with the liver disease.

“People who have bought this product should discard it if still found in their home,” Ron Chapman, California Department of Public Health director and state health officer, said in a May 31 statement. “Anyone who has consumed this specific product in the last 14 days should contact their doctor to discuss possible hepatitis A prevention and treatment options.”

Hepatitis A vaccination can prevent illness if given within two weeks of exposure to the contaminated product.

Those illness are spread across seven U.S. states: Arizona, California, Colorado, Hawaii, New Mexico, Nevada and Utah.

Of the 30 cases with information available, 11 people have been hospitalized. Twenty (66 percent) of those cases are women, and ages range from 2 to 71 years old.

Townsend Farms issued a recall of the berry mix on June 4. Costco said it has notified customers who have purchased the product since February 2013, and removed all recalled bags from store shelves.

The recalled berries were also sold at Harris Teeter stores under the name “Harris Teeter Organic Antioxidant Berry Blend” in 10 ounce bags. Those bags are marked with Lot Codes of T041613E and T041613C, with a “BEST BY” code of 101614.

At this time, no illnesses have been associated with the berries purchased at Harris Teeter stores.

Some Costco customers have begun reporting that Costco is offering free hepatitis A vaccines to customers who purchased the berries. Those who ate the berries within the last two weeks and have not yet developed symptoms of hepatitis A infection may still prevent illness by getting vaccinated.

Anyone who has had a hepatitis A vaccine in the past and ate the recalled berries should not fall ill.